Modern approaches to the treatment of chronic heart failure

According to Russian epidemiological studies, the prevalence of CHF in the Russian Federation increased from 6.1 to 8.2% over a 20-year observation period. Modern therapy has reduced both the number of rehospitalizations due to CHF decompensation and mortality. In the Russian Federation, the average annual mortality among patients with clinically evident CHF is 12%. Reducing mortality and the number of hospitalizations is the main criterion for the effectiveness of therapeutic measures. Objective of the study: The objective of our study: to evaluate the effectiveness of ARNI in quadruple therapy in patients with CHF with a low left ventricular ejection fraction (CHFrEF). A total of 48 patients with stage 2 CHF with reduced ejection fraction (EF<40%) were examined: group 1 included 28 patients who received ARNI (valsartan+sacubitril, Uperio, Novartis, Switzerland) as part of a four-component combination therapy at a starting dose of 50 mg 2 times a day, group 2 included 20 patients receiving an angiotensin-converting enzyme inhibitor (ACE) – perindopril 5-10 mg/day. Patients were examined upon admission to hospital, after 1 and 6 months of treatment. During treatment, patients in both groups achieved target blood pressure levels. At the same time, the clinical effect in the treatment of patients with CHFrEF with ARNI developed faster, which was accompanied by achieving the target blood pressure level (p<0.01), reducing dyspnea and edema by the end of the first week. As a result of treatment in the 1st group, significant improvement in cardiac function was noted already after 1 month of treatment (p<0.05), after 6 months, further improvement in LVEF and cardiac volumes was observed (p<0.01). In the 2nd group, against the background of treatment, a slight improvement in these parameters was revealed after 1 month (p>0.05), and reliable improvement was noted only after 6 months of treatment (p<0.05). The drug Uperio demonstrated a significant advantage in reducing the NT-proBNP level by the end of the first month of treatment already at the starting dose of the drug (p<0.01). In both groups, improved exercise tolerance was observed. Moreover, after 1 month of treatment in the 1st group, the increase in the six-minute walk test was reliable, and in the 2nd group - only a tendency to its increase. It was found that Uperio, compared with perindopril, reduces the risk of rehospitalization. Thus, when treating patients with CHF with ARNI, the clinical effect develops quickly, is accompanied by good tolerability, improved hemodynamic parameters, which leads to a decrease in the functional class of CHF and an improvement in the prognosis of the disease.

1. Ageev FT, Ovchinnikov AG. Diastolic heart failure: 20 years later. Сurrent issues of pathoge nesis, diagnosis and treatment of heart failure with preserved LVEF. Kardiologiia. 2023;63(3):3-12. (In Russ.). https://doi.org/10.18087/cardio.2023.3.n2376.

2. Galyavich AS, Nedogoda SV, Arutyunov GP, Belenkov YuN. About the classification of heart failure. Russian Journal of Cardiology. 2023;28(9):5584. (In Russ.). http://doi.org/10.15829/1560-4071-2023-5584. EDN ZGXELX.

3. Kalimulin OA, Rudchenko IV, Kol’tsov AV, Shcherbatyuk OV, Bologov SG, Kachnov VA. Experience with the use of the first representative of the ARNI class (angiotensin receptor and neprilysin inhibitor) sacubitril/valsartan in patients with cardiopulmonary pathology. Izvestija Rossijskoj voenno-medicinskoj akademii. 2019;1(38):27–29. (In Russ.). https://doi.org/10.17816/rmmar26112. EDN GTQRNW.

4. Galyavich AS, Tereshchenko SN, Uskach TM, Ageev FT, Aronov D.M, Arutyunov GP, Begrambekova YuL, et al. Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2024;29(11):6162. (In Russ.). http://doi.org/10.15829/1560-4071-2024-6162. EDN WKIDLJ.

5. Polyakov DS, Fomin IV, Belenkov YuN, Mareev VYu, Ageev FT, Artemjeva EG, Badin YuV, et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4):4-14. (In Russ.). https://doi.org/10.18087/cardio.2021.4.n1628.

6. Tereshhenko SN, Cheremisina IA, Safiullina AA. Possibilities of improving therapy for chronic heart failure based on the results of the multicenter observational study BYHEART. Terapevticheskij arhiv. 2022;94(4);517–523. (In Russ.) https://doi.org/10.26442/00403660.2022.04.201450.

7. Shljahto E.V. Classification of heart failure: focus on prevention. Rossijskij kardiologicheskij zhurnal. 2023;28{1}:7–8. https://doi.org/10.15829/1560-4071-2023-5351.

8. Kamiya K., et al. Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure. Circ. Hear. Fail. 2020;13 (10). https://doi.org/10.1161/CIRCHEARTFAILURE.119.006798.

9. Lam CSP, Voors AA, Ponikowski P, McMurray JJV, Solomon SD. Time to rename the middle child of heart failure: heart failure with mildly reduced ejection fraction. Eur. Heart J. 2020; 41(25):2353–2355. https://doi.org/10.1093/eurheartj/ehaa158.

10. Wehner GJ, et al. Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie? Eur. Heart J. 2022; 41(12):1249–1257.https://doi.org/10.1093/eurheartj/ehz550